Slimming lessons from South Africa

decliners, over half perceived themselves not at risk. 85.2%would accept the rapid test, including 35.6% of those whodeclined the standard test. Of midwives questioned,92.8% agreed/strongly agreed that there is a role for theRPOCT on the delivery ward and 97.2% would be happy tooffer the test with appropriate training and guidance.

Conclusions: There is a favourable response to theRPOCT as midwives deem it appropriate for a variety ofperinatal settings. Most importantly, it is acceptable toa clinically significant proportion of those who decline thestandard test (21 of 59) and therefore has the potentialto increase screening and detection rates. Hence, allowingfor early diagnosis and the initiation of antenatal interven-tions, which could reduce the rate of mother-to-child trans-mission (MTCT) in the UK.

P 002

TUBERCULOSIS SPECIALIST NURSE INTERVENTIONINCREASES UPTAKE OF HIV TESTING IN PATIENTSDIAGNOSED WITH TUBERCULOSIS

Tan Lionel K, Vavilikolanu RadhikaKing George Hospital, Barley Lane, Goodmayes,Essex IG3 8YB

Background: Tuberculosis has an increased prevalencein HIV infected individuals, with an estimated 50% lifetimerisk of developing active tuberculosis if infected with HIV.The London Regional Office of the Communicable DiseaseSurveillance Centre (CDSC) has stated that all patients diag-nosed with tuberculosis (TB) should be offered an HIV test.King George Hospital is within the North East London Strate-gic Health Authority. In 2003, only 34.4% of patients with TBwithin the region were offered an HIV test. Since this time,local hospital practice has changed; TB specialist nurses areseeing patients and offering HIV testing early in the treat-ment course, and multilingual patient literature is providedto all patients informing them that HIV testing is a routinepart of management.

Method: A retrospective audit was undertaken from thehospital TB database looking at all new TB diagnoses fromJanuary to July 2006. Of 92 patients, six were excluded asthey were on TB chemoprophylaxis only. All remaining pa-tients were analysed, including two patients who were ini-tially smear positive but subsequently cultured atypicalmycobacteria.

Results: The median age at TB diagnosis was 34.8years; 48% were female. 60% of patients were from theIndian subcontinent whilst 20% were from Sub SaharanAfrica. 47% of cases were pulmonary. 79% (67) were of-fered an HIV test. Six tested HIV positive and eight de-clined the test. All patients diagnosed with HIV werefrom Sub Saharan Africa. Of those not offered the test,three were already known to be HIV positive and twowere over 65 years. The reason for not offering thetest was not stated in the majority.

Conclusion: The proportion of newly diagnosed TB pa-tients who have been offered HIV testing has increased.As 8.9% of our patients were HIV positive, HIV testing shouldbe a routine part of management. The greater involvement

of TB specialist nurses and the availability of patient liter-ature have helped to increase the uptake of HIV testing.

Abstracts e49

P 003

SLIMMING LESSONS FROM SOUTH AFRICA

Sutherland Rebecca, Angus BrianJohn Warin Ward, Churchill Hospital, Headington, Oxford

A 36 yr old, HIV positive male, from South Africa presentedto hospital with a history of pleuritic chest pain andabdominal pain. His past medical history included tubercu-losis, syphilis and Taenia saginata infection. He had also beensuffering from chronic diarrhoea for over a year. His CD4count was 320 with a viral load of >100,000. His antiretrovi-rals had been stopped to see if the diarrhoea would settle, af-ter excluding an infective source.

The patient’s respiratory complaint was secondary todisseminated pneumococcal disease. He was treated withintravenous antibiotics and required five nights on ITU fornon invasive ventilation and monitoring.

On return to the infectious diseases ward the patientsettled. He was left with a predominant complaint ofdiarrhoea and flatulence. He had been diagnosed withpancreatic insufficiency as a cause for his chronic diarrhoeabut Pancreatin supplements made little difference to hissymptoms. Multiple stool samples were sent for culture,microscopy and CDT toxin detection with no positive result.At this point he weighed 35kg- his usual weight was 55kg.Extensive imaging of his abdomen was unremarkable. En-doscopy of the gastrointestinal tract revealed one calcifiedschistosomal egg in the colon and non specific duodenitis.Antiretroviral therapy was recommenced. Gastroenterologyreview advised an empirical course of ciprofloxacin, in caseof malabsorption, secondary to bacterial overgrowth.

As the patient’s condition deteriorated and his weightapproached 30kg he was commenced on an empiricalcourse of anti tuberculosis medication and fed with totalparenteral nutrition. A further colonoscopy and biopsyshowed Isospora belli cysts in the mucosal wall. Thesehad not been seen on numerous samples sent for stool mi-croscopy. The patient was successfully treated with tri-methoprim/sulfamethoxazole and is now back at workand weighs over 60kg.

This parasitic infection was high on the differential whenthe patient first presented with diarrhoea but it wasdiscredited due to false negative microscopy. Centreswhere these infections are rare should consider sendingsamples to laboratories with greater exposure to parasiticinfection before the diagnosis is excluded.

P 004

A SIMPLE PAIN IN THE GROIN?!

Tonna I, McGoldrick C, Laing RBSInfection Unit, Aberdeen Royal Infirmary, Aberdeen AB219WH